It’s an odd thing, isn’t it? Death and dying are somehow bigger issues in our lives than the beginning of life. It’s one thing that we have to die, and it’s bad enough that our bodies are such that our demise typically won’t be quick and painless, but it’s quite another that as 21st century societies we fail to get on top of those problems.

A few weeks ago a conservative backbencher Steven Fletcher introduced a private members’ bill in the House of Commons, aiming to decriminalize assisted dying. Fletcher had an encounter with a moose in 1996 that left him quadriplegic. He was appointed by Stephen Harper to cabinet in 2008, reportedly and famously quipping, ‘I would pinch myself if I could.’

It is interesting that a quadriplegic would introduce this legislation. For starters, often we hear ‘concerns’ from disability activists that disabled people would be the victims of assisted dying legislation. Shamelessly the specter of Nazism is wheeled in to make that case. The reality is that it isn’t disabled people who typically avail themselves of assisted dying in jurisdictions that have decriminalized it. Your average patient availing himself (yes, himself) of assisted dying is a well-educated male cancer patient toward the end of his life. I’m not making this up, this is one of the results of a large-scale survey on end-of-life decision-making in European jurisdictions that have decriminalized assisted dying. Fletcher clearly knows what he is doing. There is no evidence that the decriminalization of assisted dying puts the lives of disabled people at risk. Seemingly that doesn’t quite stop activists from being ‘concerned’ and ‘affected’ anyway. Who cares about evidence when it comes to our death and dying?

Talking about evidence. Harper government minister Peter Mackay doesn’t seem to appreciate the concept of evidence terribly well at all either. He responded to Fletcher’s proposal by saying that his conservative government doesn’t wish to re-open this debate, because it would lead us down a slippery slope to terrible things. Remarkably the scientific evidence we have from all jurisdictions that have decriminalized shows that this slippery slope is entirely imaginary. Meanwhile the Liberal Party of Canada, whose official policy is to support the decriminalization of assisted dying, was nowhere to be seen or heard from on Fletcher’s proposed bill. Would that have anything at all to do with its current leader’s unwillingness to even vote himself on the topic during the party’s most recent congress? I do wonder whether Mr Trudeau hopes to get elected on his hair-do, impeccable smile and the occasional swear word alone.

The other week I was invited to address members (and guests) of the local chapter of Dying with Dignity. The big turn-out suggests to me that this topic really is important to many people. There were the inevitable doubts about facts of the matter, as in ‘you and your facts probably lie to me, I have my own facts.’ I suspect that in the age of 24 hour cable news outlets like Sun News or Fox News, this has really become a free-for-all. It is difficult to argue with folks who think there’s a pandemic of abuse going on in countries that have decriminalized, and that it’s all hidden from public view by an unholy alliance of murderers, mass media and presumably us secular bioethics people.

On to a different end-of-life matter altogether: When are we dead actually? You might recall some recent cases in the United States where folks who were declared dead by neurological criteria were declared ‘not-dead-yet’ by interested family members and conservative religious campaigners. The thing about neurological criteria is that they are quite sensible actually, and they are currently being used in Canada, too. They do require essentially that the brain has ceased to function, and that this cessation of functioning is irreversible. Being in a coma alone isn’t sufficient for a ‘brain death’ verdict. Well, when someone is brain dead it is quite possible to keep the body ticking for awhile longer. That is achieved by means of encouraging the heart to keep beating and by means of providing oxygen to our lungs. In fact, it is possible to keep our bodies going for a few days up to a maximum of a few weeks, but eventually we will begin to decompose. We just won’t be back to watch another episode of Game of Thrones. That’s the irreversible nature of brain death.

Transplant experts agree that death by neurological criteria isn’t the only way to approach the definition of death. They are glad that we have an alternative route, namely death by cardiological criteria. If your heart is gone, arguably you won’t be back to watch Game of Thrones either. However, it is possible for such patients to be not-dead-yet by neurological criteria. Still, we know that about 5 minutes after your heart has ceased beating on its own, blood circulations ends. Brain death is an inevitable consequence of this. There has been a bit of an argument about this. Some people are worried that we might have moved too quickly on the cardiac death frontiers. They think there are undue pressures to extract organs for transplantation purposes quickly, and so people see themselves declared dead when – in these critics’ judgments – they are not-quite-dead-yet. On the other side of the equation are relatives of loved ones who have seen that the deceased organs were not used for transplantation purposes simply because clinicians waited too long to declare the patient dead by cardiological criteria. They criticize that their loved one was explicit in their wish that their organs be used after their death to preserve another human’s life. That wish was thwarted because clinicians were too reluctant to declare the patient dead. It’s a difficult call, it seems, to actually declare someone dead, despite our fanciful technologies.